Heart Failure in Focus

In the last year we have seen the publication of multiple guidance documents on the management of heart failure, each setting new standards for the management of HFpEF, including two national guidelines and a consensus statement on the phenotyping of HFpEF. Why do we need so many guidance documents? What was the rationale behind their development? And how concordant are they? In the final episode of Heart Failure in Focus for 2023, Dr Muthiah Vaduganathan is joined by Prof Giuseppe Rosano (St George’s Hospital London, UK), who played a central part in the development of the 2023 European heart failure guideline focussed update and an earlier publication on HFpEF phenotyping. He shares his thoughts on these aforementioned questions and together with our host, provide a practical interpretation of how to incorporate the three distinct documents into daily practice. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.

In this month's episode, our host Dr Muthiah Vaduganathan speaks with Prof Xavier Cos, a general practitioner and Innovation Officer at Institut Català de la Salut, Barcelona, ES, and Chairman of Primary Care Diabetes Europe, to discuss the current and future role of primary care in heart failure (HF). During the first part of this episode we hear how primary care is ideally positioned to provide early screening and detection of HF – even if practitioners do not consider themselves HF specialists – and how this is key to alleviating the current levels of clinical inertia. The broader role of primary care and general practice is then considered in terms of managing recent hospitalisations and preventing future admissions, ordering diagnostic tests, treatment and referral. Finally, we consider the future role of primary care and the need for a move towards a more coordinated model of care. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.

In this month's episode, our host Dr Muthiah Vaduganathan speaks with Dr Kieran McCafferty, Consultant Nephrologist at Barts NHS Health Trust London, and Senior Clinical Lecturer at Queen Mary University of London, about the growing need for effective management strategies in cardiorenal disease. After touching on the current epidemiology of co-existing CKD and heart failure (HF), Kieran gives a first-hand assessment on the unique challenges of diagnosing HF in CKD. We discuss the evolution of drug treatment in CKD and how cardiorenal patients are now benefitting from the same classes of agents as HF patients. Finally, we talk about collaborative care and hear about Kieran’s own model for optimising guideline-directed medical therapy in his joint service. Do you want to learn more? Catch up now on this roundtable, where we examine how the broader heart failure team can work together effectively and consider best practices for referral and initiation of foundational medical therapy. https://www.radcliffecardiology.com/video-index/examining-complex-heart-failure-case

This month we are joined by Dr Mikhail Kosiborod, clinical trialist, Professor of Medicine at St Luke’s Heart Institute and leading expert on Quality of Life (QoL) instruments world-wide. Dr Kosiborod discusses functional and QoL outcomes of foundational therapies in Heart Failure (HF) and the clinical application of this data. Additionally, we learn how scoring systems like the Kansas City Cardiomyopathy Questionnaire (KCCQ) can be used to establish clinically meaningful change in functional status. Finally, we consider how regulators future guideline development might start to look beyond the New York Heart Association (NYHA) classification and embrace QoL and overall health status when assessing HF treatments. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.

Multiple clinical trials evidence the long-term benefits of guideline-directed medical therapy in heart failure (HF), and international guidelines make clear recommendations for its rapid initiation. But this hasn’t translated into optimal treatment for most patients in the real-world. So, what steps can we take to reverse this trend? In this month’s episode, we speak with Dr Tariq Ahmad MD, Chief of Heart Failure at Yale University, and author of several recent behavioural and implementation studies in HF, including REVeAL-HF and PROMPT-HF. In this conversation, we get to grips with the reality of sub-optimal treatment and discuss some possible ways forward using behavioural “nudges” embedded within electronic health records. We also consider the barriers faced in everyday practice that obscure optimal therapy for so many patients. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.

Heart failure is a complex disease and whilst clinical practice guidelines posit the “four pillars” as the cornerstone of effective medical management, the very nature of heart failure means that most patients have multiple comorbidities that also need to be addressed. This month, we welcome Biykem Bozkurt – the Mary and Gordon Cain Chair and Professor of medicine at Baylor College of Medicine, Texas – a true pioneer in translational research and a lead contributor to clinical practice guidelines, including the 2022 AHA/ACC/HFSA guidelines. There is perhaps no better guest to ask some of the most challenging questions around implementing guideline directed medical therapy (GDMT): reviewing GDMT in valvular heart disease patients; initiating GDMT whilst addressing non-cardiac comorbidities; to where medical treatment is evolving, beyond the central dogma of the “four pillars”. All of this and more are covered in this fascinating and insightful discussion. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.

Join us for our second podcast in the series where our host Dr Muthiah Vaduganathan continues the theme of SGLT-2 inhibitors in heart failure. This month’s guest is Prof Carolyn Lam who, together with Muthu will be answering your questions about SGLT-2 inhibitors and the practical management of heart failure patients. All of the questions answered in this podcast have been submitted by real practitioners who manage heart failure on a daily basis, so there’s every chance that if you’ve had a burning question on this topic, Muthu and Carolyn will be answering it. These wide ranging questions cover themes across the practical use of SGLT-2 inhibitors such as the use of diuretics, choosing between different SGLT-2 inhibitors and their use in specific patient sub-groups, to the methodology and results of the recent DELIVER trial and other trials in HFpEF patients. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.

Until recently, guideline directed medical therapy for HFpEF and HFmrEF was aimed at symptom control with mostly diuretic-based treatments. The publication of EMPEROR-PRESERVED in 2021 prompted changes in the AHA/ACC/HFSA guidelines, assigning a 2a recommendation across the SGLT-2 inhibitor class for use in this patient population. Since then, the heart failure community has been waiting in anticipation for the results of DELIVER – the largest SGLT-2 inhibitor trial in this population to date and viewed by many, as an important validation of this class of medication in HFpEF/HFmrEF. In this first episode of our new podcast series, Heart Failure in Focus, Dr Muthiah Vaduganathan is joined by Prof Scott Solomon to discuss the DELIVER data which was released at the ESC Congress 2022 in Barcelona. During this fascinating interview, you will get insight into the uniqueness of the DELIVER trial design, the importance of its design for key patient groups and what the results mean for clinical practice. Questions can be sent via Twitter to our host @mvaduganathan or to @radcliffeCARDIO. This podcast is supported by an unrestricted educational grant from AstraZeneca.

Presenting our new podcast series Heart Failure in Focus, hosted by Muthiah Vaduganathan.